Open Access Study protocol

Change in alcohol outlet density and alcohol-related harm to population health (CHALICE)

David Fone1*, Frank Dunstan1, James White2, Chris Webster3, Sarah Rodgers4, Shin Lee3, Narushige Shiode3, Scott Orford35, Alison Weightman6, Iain Brennan7, Vas Sivarajasingam8, Jennifer Morgan1, Richard Fry4 and Ronan Lyons4

Author Affiliations

1 Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK

2 Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK

3 School of City and Regional Planning, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WA, UK

4 Health Information Research Unit, School of Medicine, Swansea University, Swansea, SA2 8PP, UK

5 Wales Institute of Social and Economic Research, Data and Methods (WISERD), Cardiff University, 46 Park Place, Cardiff, CF10 3BB, UK

6 Support Unit for Research Evidence, Information Services, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK

7 Department of Social Sciences, University of Hull, Cottingham Road, Hull, HU6 7RX, UK

8 School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK

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BMC Public Health 2012, 12:428  doi:10.1186/1471-2458-12-428

Published: 12 June 2012



Excess alcohol consumption has serious adverse effects on health and violence-related harm. In the UK around 37% of men and 29% of women drink to excess and 20% and 13% report binge drinking. The potential impact on population health from a reduction in consumption is considerable. One proposed method to reduce consumption is to reduce availability through controls on alcohol outlet density. In this study we investigate the impact of a change in the density of alcohol outlets on alcohol consumption and alcohol-related harms to health in the community.


A natural experiment of the effect of change in outlet density between 2005–09, in Wales, UK; population 2.4 million aged 16 years and over. Data on outlets are held by the 22 local authorities in Wales under The Licensing Act 2003.

The study outcomes are change in (1) alcohol consumption using data from annual Welsh Health Surveys, (2) alcohol-related hospital admissions using the Patient Episode Database for Wales, (3) Accident & Emergency department attendances between midnight–6am, and (4) alcohol-related violent crime against the person, using Police data.

The data will be anonymously record-linked within the Secure Anonymised Information Linkage Databank at individual and 2001 Census Lower Super Output Area levels. New methods of network analysis will be used to estimate outlet density. Longitudinal statistical analysis will use (1) multilevel ordinal models of consumption and logistic models of admissions and Accident & Emergency attendance as a function of change in individual outlet exposure, adjusting for confounding variables, and (2) spatial models of the change in counts/rates of each outcome measure and outlet density. We will assess the impact on health inequalities and will correct for population migration.


This inter-disciplinary study requires expertise in epidemiology and public health, health informatics, medical statistics, geographical information science, and research into alcohol-related violence. Information governance requirements for the use of record-linked data have been approved together with formal data access agreements for the use of the Welsh Health Survey and Police data.

The dissemination strategy will include policy makers in national and local government. Public engagement will be through the Clinical Research Collaboration-Cymru "Involving People" network, which will provide input into the implementation of the research.

Alcohol; Outlet density; Alcohol-related harm; Anonymised record-linkage; Multilevel analysis; Spatial analysis